Handoffs: Transitions of Care for Children in the Emergency Department

From the AAP:

Handoffs of care — also known as transitions of care — occur when the responsibility for a patient’s care moves from one health care provider to another. Handoff processes in other high-risk industries, such as aerospace, aviation and nuclear power, are noted to be structured and have become fine-tuned.

Health care is realizing that processes used in other industries have a role in ensuring safe and quality care for patients. Consistently structuring two-way communication that is scripted, precise, impersonal and efficient within a framework that allows for reassessment and read-back of information is extremely valuable.

A new AAP policy statement and clinical report highlight best practices and offer evidence and rationale for standardizing handoff processes. The policy Handoffs: Transitions of Care for Children in the Emergency Department is available at http://dx.doi.org/10.1542/peds.2016-2680 and is jointly issued by the AAP Committee on Pediatric Emergency Medicine, the American College of Emergency Physicians and Emergency Nurses Association. The clinical report Standardization of Inpatient Handoff Communication, from the AAP Committee on Hospital Care, is available at http://dx.doi.org/10.1542/peds.2016-2681. Both will be published in the November issue of Pediatrics.

Surge in prescription opioid poisoning among U.S. youth

From Reuters:

The number of children and teens hospitalized for prescription opioid poisonings has more than doubled in recent years, with both accidental overdoses and suicide attempts on the rise, a U.S. study suggests.

Annually, the rate of these opioid poisonings among youth up to 19 years old surged from 1.4 per 100,000 children in 1997 to 3.71 per 100,000 kids by 2012, the study found.

How working night shifts furthers health disparities

From Becker’s:

Night-shift jobs and their associated health risks tend to fall on the shoulders of those of lower socioeconomic status. As a result, risks of “shift work” tend to go ignored among a population in which chronic health issues are already pervasive, according to The Atlantic.

The International Agency for Research on Cancer has called night shifts “probably carcinogenic,” according to the report. Other harmful health effects include higher risks of coronary artery disease, diabetes, weight gain and some forms of cancer.

However, these health risks are most closely associated with the practice of “shifting” or “shift work,” in which one frequently switches from night shifts to day shifts. Brain studies among those who’ve done shift work for at least a decade indicate cognitive decline years in advance, according to the report.

TeamHealth bought by Blackstone Group for $6.1 billion

From Modern Healthcare (hat tip: Dr. Menadue):

Physician staffing giant TeamHealth has agreed to be purchased by affiliates of the Blackstone Group for $6.1 billion.

Blackstone, one of the nation’s largest private-equity groups, intends to pay $43.50 per share for TeamHealth, which changed its CEO last month in light of slumping earnings and stock price.

The Blackstone price is an 18% premium above TeamHealth’s Friday closing stock price of $36.85.

Predictors of Influenza Among Older Adults in the Emergency Department

From Infection Control Today:

Diagnosis of influenza in older adults may be complicated by atypical presentations or when patients present with complications of an underlying illness. Lam, et al. (2016) aimed to identify clinical characteristics and epidemiological factors associated with influenza among community-dwelling adults aged ≥60 years presenting to emergency departments.

The researchers identified patients with influenza-compatible chief complaints presenting to emergency departments of six acute care hospitals in Ontario, Canada during the 2011/12 and 2012/13 influenza seasons. Clinical characteristics, medical history and demographics were collected by patient interview, chart review and by contacting vaccine providers. Nasopharyngeal swabs were tested for influenza using polymerase chain reaction. We modeled predictors of influenza using multivariable logistic regression models that compared individuals with and without influenza.

Of 1,318 participants, 151 (11%) had influenza (98 A/H3N2, 12 A/H1N1, 4 A [not sub-typed], 37 B). In the multivariable model, clinical symptoms associated with influenza were cough (OR 6.4, 95% CI 3.2, 13.0), feverishness and/or triage temperature ≥37.2 °C (OR 3.0, 95% CI 2.0, 4.7), 2–5 days from symptom onset to the emergency department visit (OR 2.2, 95% CI 1.5, 3.2), and wheezing (OR 2.1, 95% CI 1.3, 3.3). The effect of cough on influenza increased with older age. Epidemiological factors associated with increased odds for influenza included weeks when ≥10% influenza tests from provincial laboratories were positive (OR 5.1, 95% CI 1.2, 21.7) and exposure to a person with influenza-like illness (OR 1.9, 95% CI 1.3, 2.8). Among participants with influenza, only 47 (31%) met the Centers for Disease Control and Prevention criteria for influenza-like illness (temperature ≥37.8 °C and cough and/or sore throat).

As in younger adults, cough and feverishness are the two symptoms most predictive of influenza in the elderly. Current influenza-like illness definitions did not adequately capture influenza in older adults, the researchers conclude.

Many children rely on emergency room for psychiatric care

From Spectrum:

Compared with patients who have physical illnesses, the researchers found that people with mental health conditions rely more on the emergency department, and are more likely to be admitted when they show up. They tend to stay longer, too. The researchers have not yet described how the visits broke out by age. But anecdotally, children and older patients — “the extremes” — appear particularly affected, says Suzanne Lippert, clinical assistant professor of emergency medicine at Stanford University in California, and lead author on the abstracts.

Using telemedicine in mental health emergencies increases access, lowers costs

From Healio:

Using a telemedicine evaluation for pediatric mental health emergencies in ED or urgent care facilities may improve access to mental health services and reduce costs, according to recent study findings presented at the 2016 AAP National Conference and Exhibition.

“Pediatric mental health emergencies represent an escalating segment of pediatric psychiatric emergency services that impacts one in five children,” Alison Brent, MD, of Children’s Hospital Colorado, Aurora, wrote. “Pediatric emergency department and urgent care sites are vital for initial stabilization of patients with [mental health emergencies] in conjunction with evaluation and ultimate disposition by pediatric trained [mental health specialists]. A system that provides safe and timely evaluation of [mental health emergencies] is challenging from a resource perspective, especially when patients present at a site distant from mental health specialists.”

“Regulators crack down on telemedicine, denying patients options”

From the Chronicle:

There are dozens, if not hundreds, of common conditions that doctors or nurses can diagnose using today’s telecommunications.

Despite the promise of this technology, the Texas Medical Board adopted a new rule that would require a doctor to meet a patient face-to-face before writing a prescription, or alternatively, the doctor can have a medical professional in the room with the patient to conduct an exam. The rule, adopted last year, was supposed to go into effect last June, but Dallas-based Teladoc sued in federal court, and the case is pending.

 The rule would have destroyed Teladoc’s business model, which is to have doctors available to consult patients 24 hours a day via phone or some other device. On weekends, a doctor can sit at home watching a football game, answer the phone, solve a patient’s simple problem and keep that patient out of the emergency room, where the same outcome would have cost 20 times more.

Wisconsin addresses shortage of rural doctors

From the Journal Sentinel:

As the state’s rural population ages, increasing its need for health care, Wisconsin is facing a shortage of physicians in rural areas that is projected to get much worse in coming decades.

To address it, the University of Wisconsin School of Medicine and Public Health, the Medical College of Wisconsin and the state’s health systems are developing residency programs in rural areas — knowing that doctors are more likely to practice where they do their training.

California Rules About Violence Against Health Workers Could Become A Model

From NPR:

Workers in California’s hospitals and doctors’ offices may be less likely to get hit, kicked, bitten or grabbed under workplace standards adopted by a state workplace safety board.

Regulators within the California Division of Occupational Safety and Health approved a rule last Thursday that would require hospitals and other employers of health professionals to develop violence prevention protocols and involve workers in the process. The standard now will be reviewed by the Office of Administrative Law, which proponents expect will approve the new rules. The earliest they could take effect would be January 2017.

“This is a landmark day for the entire country,” said Bonnie Castillo, a registered nurse who is director of health and safety for the California Nurses Association/National Nurses United, which represents 185,000 registered nurses across the U.S.